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Self-belief: holistic psychiatry in a secular age: Commentary on … Holistic psychiatry without the whole self

  • Christopher C. H. Cook (a1)
Summary

Charles Taylor provides important philosophical accounts of what it means to be a ‘self’ in a secular age. Psychiatry has not traditionally concerned itself with other than limited accounts of the concept of the self but Taylor's work sheds a revealing light on the challenges to be met by aspirations to an holistic practice of psychiatry in our secular age.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Christopher C. H. Cook (c.c.h.cook@durham.ac.uk)
Footnotes
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See special article, pp. 97–100, this issue.

Declaration of interest

C.C.H.C. is Chair of the Spirituality and Psychiatry Special Interest Group (SPSIG) at the Royal College of Psychiatrists. The views expressed in this article are his own. The SPSIG does not adopt any particular position in relation to the matters debated in this article, but welcomes open debate about this and other matters related to spirituality and psychiatry, both in publication and at its meetings. C.C.H.C. is an Anglican priest.

Footnotes
References
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1 Crossley, DR. Evolving notions of the self and moving towards holistic psychiatry. Psychiatrist 2012; 36, 97100.
2 Taylor, C. Sources of the Self: The Making of the Modern Identity. Cambridge University Press, 1989.
3 Taylor, C. A Secular Age. Belknap, 2007.
4 Cook, CCH. The faith of the psychiatrist. Ment Health Relig Cult 2011; 14: 917.
5 Koenig, HG. Faith and Mental Health. Templeton Foundation Press, 2005.
6 Americian Psychiatric Association. Guidelines regarding possible conflict between psychiatrists' religious commitments and psychiatric practice. Am J Psychiatry 1990; 147: 542.
7 Cook, CCH. Recommendations for Psychiatrists on Spirituality and Religion (Position Statement PS03/2011). Royal College of Psychiatrists, 2011.
8 General Medical Council. Good Medical Practice. GMC, 2006.
9 General Medical Council. Personal Beliefs and Medical Practice. GMC, 2008.
10 Koenig, HG. Religion and mental health: what should psychiatrists do? Psychiatr Bull 2008; 32: 201–3.
11 Poole, R, Higgo, R, Strong, G, Kennedy, G, Ruben, S, Barnes, R, et al. Religion, psychiatry and professional boundaries. Psychiatr Bull 2008; 32: 356–7.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Self-belief: holistic psychiatry in a secular age: Commentary on … Holistic psychiatry without the whole self

  • Christopher C. H. Cook (a1)
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eLetters

Holistic Psychiatry

Christopher C. H. Cook, Professorial Research Fellow
10 April 2012

David Crossley's paper on the self and holistic care (1) is timely inthe context of the heated debate over the place of spirituality and religion in clinical practice. In a commentary on this paper, one of us (CCHC) (2), raised the difficult matter of challenging unhealthy spiritual/religious beliefs. In the course of making a point about the difficulties this entails, reference was made to a letter (3) from a previously published correspondence between us, suggesting that one possible response might be to argue that "matters such as religion and spirituality should be excluded from all clinical practice". This gave theunfortunate impression that the authors of that letter had taken this position. We would collectively like to correct this.

We are agreed that it would be impossible to completely exclude consideration of religion and spirituality from all aspects of clinical practice. Psychopathology often has religious content, and it can be important to understand the role of religion and spirituality in an individual patient's life. We are agreed that it sometimes appropriate to involve chaplains and other religious advisers in helping people sufferingfrom mental health problems. We are agreed that psychiatry cannot offer total solutions to mental illness and human unhappiness, and that in practice psychiatry is the application of a flawed science in the context of shared (but sometimes contended) professional values.

However, there are important differences between us as to best practice, and as to the proper approach to spirituality and religion when working with patients. Our fundamental disagreement concerns the extent towhich it is appropriate or possible for psychiatrists to offer holistic care to patients, spirituality and religion being one important aspect of this.

CCHC believes that spirituality should routinely be considered as an important aspect of clinical practice, even where the patient does not directly raise it for discussion and that a spiritual dimension to treatment renders it more meaningful and possibly more effective. He recognises that this creates real and complex challenges with regard to professional boundaries. However, he believes that the special expertise offered by psychiatry is at its best when actively engaged with an holistic perspective and that it is in such engagement that it becomes more apparent that psychiatry does not have all the answers. In this way, boundary issues are highlighted and the ensuing debate offers opportunities to reduce confusion and clarify good practice (4).

RP and RH believe that the concept of holistic care takes psychiatrists out of a domain where they have special expertise and that 'holism' undermines the important role of other agencies and individuals in helping people with mental illness by implying that psychiatrists have all the answers (5). They believe that holistic care invites serious boundary breaches because it creates intrinsic confusion as to appropriateprofessional behaviour and the limitations of psychiatric expertise.

So far, this debate has been polarised and somewhat abstract. It would not be helpful to deny our differences, but we share an aspiration to understand the centre of gravity of professional and service user opinion on this matter by reference to tangible dilemmas in real life practice.

Christopher C. H. Cook, Professorial Research Fellow, Durham UniversityRob Poole, Professor of Mental Health, Glynd?r University WrexhamRobert Higgo, Consultant Psychiatrist, Merseycare NHS Trust, Liverpool

1.Crossley DR. Holistic psychiatry without the whole self. The Psychiatrist. 2012;36(3):97-100.2.Cook CCH. Self-belief: holistic psychiatry in a secular age. Commentaryon... Holistic Psychiatry without the whole self. The Psychiatrist. 2012;36(3):101-3.3.Poole R, Higgo R, Strong G, Kennedy G, Ruben S, Barnes R, et al. Religion, psychiatry and professional boundaries. Psychiatric Bulletin. 2008;32:356-7.4.Cook C, Powell A, Sims A, editors. Spirituality and Psychiatry. London:Royal College of Psychiatrists Press; 2009.5.Poole R, Higgo R. Clinical Skills in Psychiatric Treatment. Cambridge: Cambridge University Press; 2008.

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Conflict of interest: CCHC is Chair of the Spirituality & Psychiatry Special Interest Group of the Royal College of Psychiatrists. The views expressed here are his own, and do not necessarily represent those of the Group. He is Director of the Project for Spirituality, Theology & Health at Durham University, and is an Anglican Priest. RP is an atheist. RH is a Buddhist.

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